1396998498 NPI number — DR. DONALD LEE PEARSON D.D.S.

Table of content: DR. DONALD LEE PEARSON D.D.S. (NPI 1396998498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396998498 NPI number — DR. DONALD LEE PEARSON D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARSON
Provider First Name:
DONALD
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396998498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23251 DART DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEHACHAPI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-821-1839
Provider Business Mailing Address Fax Number:
661-821-1839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22844 VIRGINA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALIFORNIA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-821-1839
Provider Business Practice Location Address Fax Number:
661-821-1839
Provider Enumeration Date:
11/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  CA24586 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)